Examining mental health in Arctic Alaska

Valerie Davidson, commissioner of the Alaska Department of Health and Social Services, sits in her midtown Anchorage office Friday. Davidson was appointed commissioner by Gov. Bill Walker and began her appointment on Dec. 1, 2014. (Laurel Andrews/Alaska Dispatch News)
Valerie Davidson, commissioner of the Alaska Department of Health and Social Services, sits in her midtown Anchorage office Friday. Davidson was appointed commissioner by Gov. Bill Walker and began her appointment on Dec. 1, 2014. (Laurel Andrews/Alaska Dispatch News)
When Alaska Health and Social Services Commissioner Valerie Davidson parked her car in downtown Anchorage Monday and walked to the swanky Hotel Captain Cook for a meeting with prominent policymakers, she did what she always does when walking by down-and-out people living on the street.

“I looked at every single person that I passed,” Davidson told the U.S. Arctic Research Commission. “And, as always, I was looking for my sister.”

Davidson said her sister, a “brilliant” woman who has worked at various levels of state government, struggles with addiction and has been “homeless for years.”

 “How heartbreaking it is to know I’m in the position I’m in and have all the resources in the world, and yet I can’t help her,” said Davidson, an attorney and veteran of tribal health organizations who was appointed commissioner last year by Gov. Bill Walker.

Setting priorities

The U.S. Arctic Research Commission, which advises the president and Congress on Arctic science policy, is grappling with the task of setting priorities for mental-health and behavioral-health research.

Davidson, a Yup’ik who spent much of her childhood in the Southwest Alaska village of Aniak and in the regional hub of Bethel, has a family story common in Alaska and the entire circumpolar north. Behavioral-health and mental-health problems, though pervasive in the far north, are often overshadowed by environmental challenges like climate change, pollution and ocean acidification.

But mental-health and behavioral issues pose dire risks to Arctic residents, who suffer from high rates of violence and depression. In 2009, the Arctic Council launched a human-health initiative that included recommendations for improving behavior and mental well-being around the circumpolar north.

The U.S. commission is seeking to follow up on those mental- and behavioral-health recommendations, said Cheryl Rosa, the organization’s deputy director.

In its new report on research goals and objectives for 2015 and 2016, the commission lists domestic violence specifically as a priority for research, along with the better-publicized environmental subjects. Domestic violence falls under the category of “improving Arctic health,” one of six broad goals announced in May.

Domestic violence

The commission’s report on research goals and objectives acknowledges that domestic violence is part of a web of sometimes self-reinforcing mental-health and behavioral problems. A “large overlap exists” between the violence and child maltreatment, and victims of domestic violence are more likely to engage in behavior that puts them at further health risks, the report says.

Much of the existing care for affected people comes in the back end, in hospital emergency rooms, law-enforcement response and criminal punishment, experts said at Monday’s commission meeting.

Melissa Kemberling of the Mat-Su Health Foundation presented results of a study showing that in the Matanuska-Susitna Borough, where suicides occur at twice the national rate and where one in every four motor-vehicle accidents involves drugs or alcohol, mental-health and behavioral problems result in higher health costs, more frequent emergency-care visits and numerous repeat hospital visits by the same individuals.

“We could get a bigger bang for our buck by focusing upstream,” on programs that address problems before they become emergencies, Kemberling said.

Childhood trauma

Another issue to consider, said experts at the meeting, is the damage inflicted by what health professionals call “adverse childhood experiences.”

Davidson related an example of her own childhood trauma — the annual encounter that she and other kids in the village of Aniak had with visiting dentists. The children would line up in front of a closed door “and we would hear the screams of our friends,” she said. “It was terrifying.” The dentist — wearing a blood-covered apron — would beckon new patients, Davidson said, and afterwards the children asked each other one question about tooth extractions: “How many?”

“These things stay with you,” Davidson said. She mentioned a cousin now in her 30s. “To this day, she can’t even have her teeth cleaned without being fully anesthetized,” Davidson said.

Perhaps not surprisingly, Davidson became a champion of Alaska’s much-lauded dental therapist program, in which trained dental aides — many of them working in their home villages — provide oral care that helps patients maintain dental health and avoid emergencies.

The U.S. Arctic Research Commission will continue its meeting in Nome on Tuesday and Wednesday, with a session devoted to mental and behavioral health research in that region. Commission members will also hear about biological and environmental science projects underway in the Bering Strait region, according to the agenda.

Related stories from around the North:

Canada:  The elephant in the room – Mental health in Arctic communities, Blog by Heather Exner-Pirot

Finland:  OECD ‘concerned’ over high suicide rates in Finland, YLE News

Sweden:  County in Sweden’s North has best mental health in country, Radio Sweden

United States:  In Northwest Arctic, teens lead the way in suicide prevention, Alaska Dispatch

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